TOXICITY OF NONSTEROIDAL ANTIINFLAMMATORY DRUGS IN THE LARGE-INTESTINE

PURPOSE: Adverse effects of nonsteroidal anti-inflammatory drugs (NSAI DS) on the upper gastrointestinal (GI) tract and small intestine are w ell described. Evidence is also accumulating that implicate NSAIDS in inducing and exacerbating damage in the distal GI tract. The purpose o f this review is to identify possible adverse effects of NSAIDS on the large intestine and increase the clinical awareness of these toxicolo gic effects. METHODS: A literature review identified the diversity of toxicologic effects induced by NSAIDS in the large intestine. The epid emiology, pathogenesis, and clinical implications of these adverse eff ects are described. RESULTS: NSAID use has been associated with coloni c bleeding, iron deficiency anemia, strictures, ulcerations, perforati ons, diarrhea, and death. In addition, NSAIDS can exacerbate inflammat ory bowel disease and ulcerative colitis. The prevalence of NSAID-indu ced large intestinal damage is unknown. Diagnosis can be made by colon oscopy and barium scans. Although the clinical presentation of NSAID-i nduced gastropathy and enteropathy, bleeding or perforation, may be mo re dramatic than colonopathy, the overall clinical significance of the se adverse effects of NSAIDS on the large intestine has not been fully characterized. CONCLUSIONS: This review illustrates that NSAID-induce d large bowel toxicity can cause significant morbidity in some patient s, ranging from profuse diarrhea, chronic blood loss, and iron deficie ncy anemia to fatality. The pathogenesis is likely multifactorial and is thought to be related to inhibition of prostaglandin synthesis. Bec ause NSAIDS are widely prescribed and some are available without a pre scription, heightened awareness of these toxicologic manifestations th roughout the GI tract may reduce morbidity.